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General NPI Number Information
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NPI Number | 1649040684
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Entity Type | Individual
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Provider Name | LORIANN ANTEMESARIS
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Gender | Female
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 331 W CENTRAL AVE STE 225
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City | WINTER HAVEN
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State | FL
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Zip | 33880-2984
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Country | US
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Telephone | 863-206-8172
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Fax |
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Provider Business Mailing Address
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Address Line | 225 9TH ST SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3112
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Country | US
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Telephone | 863-206-8172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH22387
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License Number State | FL
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